Background: Children with disorders of gut-brain interaction (DGBI) often report poor sleep. However, the presence of sleep disorders and polysomnography (PSG) characteristics have not been previously described. Thus, we aimed to compare PSG changes in children with DGBI compared to healthy controls and describe sleep disorders seen in DGBI patients.

Methods: We conducted a retrospective review of patients ages 7-19y who met Rome 4 criteria for a DGBI without organic GI and other systemic conditions and underwent PSG at the sleep center performed within one year of the GI clinic visit. We collected demographic data, GI and sleep symptoms and diagnosis, and PSG metrics. We then compared PSG metrics of children with DGBI to a control group of healthy children ages 4-18 years from a CCHMC sleep research repository. These included total sleep time, sleep efficiency after onset, sleep stages: rapid eye movement sleep (REM), non-REM sleep stages - NREM1, NREM2, NREM3, REM cycles, and latency; sleep apnea-hypopnea index (AHI), obstructive-apnea-hypopnea index (OAHI), arousal index, arousal episodes, periodic limb movement index (PLMS-I). Linear regression analyses, adjusting age, race, and BMI, were conducted to examine differences between groups.

Results: Of 102 children with DGBI, 66% were females, 88% were Caucasian, 30% had irritable bowel syndrome, 29% had functional abdominal pain, 21% had functional dyspepsia, 13% had functional constipation, and 5% had cyclic vomiting. The mean age was 13.9y ± 3.3, and the mean BMI was 26.4 ± 7.6. Of the 203 controls, the mean age was 10.7y ± 2.6, and the mean BMI was 22 ± 6.7; 57% were females, and 64% were Caucasian. DGBI patients had significantly lower sleep efficiency after onset (p=0.002), less NREM3 (p<0.0001) and REM sleep (p=0.05), and shorter REM latency (p=0.002) and REM cycles (p=0.002) compared with healthy controls. They also had a significantly higher apnea (OAHI p<0.0001), arousal index (p<0.0001), arousal episodes (p<0.0001), and periodic limb movements (PLMI: p<0.0001). After controlling for covariates such as age, BMI, and race, there remained significant differences in several measures (p<=0.05, Fig 1). In DGBI patients, the most common sleep complaints included snoring, sleep onset issues, and excessive daytime sleepiness. The most common sleep diagnoses were obstructive sleep apnea, primary snoring, and insomnia (Fig 2).

Conclusions: Children with DGBI have obstructive sleep apnea, primary snoring, and insomnia. They have significant differences in sleep architecture including less slow wave (NREM-3) sleep (restorative for most physiologic processes) and increased apnea, arousal episodes, and periodic limb movements compared to healthy controls. Thus, a thorough investigation and treatment of sleep disorders may improve outcomes of pediatric DGBI.

DGBI = Disorders of the gut-brain interaction, NREM = Non-rapid eye movement, REM = Rapid eye movement

DGBI = Disorders of the gut-brain interaction

Rashmi Sahay

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